Open Enrollment for Businesses vs. Individuals: How It Differs, and Other Questions Answered

open enrollment for business vs individuals

Getting health insurance is a crucial part of safeguarding your well-being. Therefore, ensuring you make the right decisions during your open enrollment period is essential.
To be covered for all of life’s unexpected bumps, know the difference between open enrollment for businesses vs. individuals, so you aren’t ever left without insurance coverage in an emergency.
Knowledge is power. Don’t miss out on something vital to your welfare just because you don’t have all the necessary information.
Continue reading to understand all you need to know about open enrollment.

Table of Contents

Is Open Enrollment the Same for Businesses vs. Individuals?

Open enrollment for businesses vs. individuals can be different, and it is necessary to understand these differences.
According to the Centers for Medicare & Medicaid Services, before the end of December 2021, more than 13.6 million people signed up for their 2022 healthcare coverage using Always use trustworthy sites when you are dealing with healthcare.
For individuals, open enrollment is at the same time every year. November is the open enrollment month in Nevada, yet this can differ from state to state. Most of the time, it’s between Nov-Dec since new insurance policies start on Jan 1.
Click here to learn more about how open enrollment works for individuals.
For businesses, the open enrollment period is when the group starts with their insurance and will be at that same time every year.
Read more aboutwhat to bring to your open enrollment appointment here.

Can Businesses Move Their Open Enrollment Period?

Yes, businesses can usually move their open enrollment period.
There can be some restrictions if you are not an established client for 12 months with that particular carrier. But if you are completely changing your carrier, you can cancel your group coverage, and there are no questions asked.
If you are planning to switch carriers, start planning about 90 days before open enrollment.
Surveying employees to gauge their feelings is an effective way to open up communication about coverage.

  • If you don’t know what questions to ask your employees, use the Nevada Benefits concise three-minute survey to connect with your employees for the feedback you need to make a good decision.

Information About “Off-Enrollment”

Additionally, it is essential to realize that group insurance is a month-to-month contract so that you can move to a new carrier anytime – even during “off-enrollment.”
It is a misnomer that you can’t change your insurance coverage until the renewal period. Many businesses don’t know this because brokers will try to have companies stay longer with their policies. Nevada Benefits has a process to review your specific situation.

What Happens if an Individual or Business Misses Open Enrollment?

For businesses, if an employer misses an open enrollment window, generally, they can not sign up for benefits that year unless they have a special exception or qualifying life event, such as the following.

  • Loss of health coverage
  • Changes in household
  • Changes in residence
  • Certain changes in life circumstances

If you previously had coverage and don’t opt for renewal, you can lose coverage and be forced to pay a fine. Another option is to get a short-term health insurance plan until your open enrollment period opens again.
Request a quote or get your questions answered today.

Individual Open Enrollment: Be Aware Of These Top 4 Signs That You’re Being Scammed

Getting the right health coverage for you and your family can be overwhelming, considering all your options regarding cost and coverage.
And to add to the already challenging process, scams are prevalent these days. The Coalition Against Insurance Fraud reported that in 2020, there were $3.1 billion in false and fraudulent claims when dealing with healthcare fraud.
The good news is that if you need help, Nevada Benefits can help fix any issues and clean up any messes you get into.
Here are some tips to follow to avoid being scammed.

  1. Take your time, so you don’t make an impulsive decision. Do your research.
  2. Read carefully, especially the fine print.
  3. Verify the services offered and review the company’s website. Confirm the company’s US address and phone number.
  4. Ensure that the plan provider is licensed.
  5. Don’t enter personal, bank, or credit card information online, in an email, or over the phone.
  6. Don’t sign up for insurance without having to get a physical exam or provide your medical history. Reputable coverage means that the insurer understands their customers’ history and needs.
  7. Ask for a statement of benefits and a copy of the policy you want to purchase.
  8. Remember that scammers will use “word trickery” to get you to buy. A “PPO, Multi-State, full coverage plan” might sound enticing, be sure to ask questions like: What are my max benefits? If I have surgery, what’s it going to cost” “Is mental health covered?”

Learn more scam prevention tips here.
Find out more about Nevada Benefits today.

#1: Any “MultiPlan” Coverage

Scammers often use the phrase “MultiPlan.” This word should alert you that you are dealing with a scammer.
MultiPlan networks or medical discount plans typically offer additional providers that have agreed to offer discounted services. They charge a monthly fee for discounts on medical services from participating providers, but this is not a substitute for health insurance. These plans take your money without ever providing real health insurance.
Understanding the difference between medical discount plans and health insurance plans is imperative.

#2: Pre-Existing Conditions

Many scams “promise” clients they will cover pre-existing conditions without additional costs. However, in some cons, you can end up with expensive medical bills.
The U.S. Department of Health & Human Services reports that responsible health insurers can’t deny coverage or charge more due to pre-existing conditions such as:

  • Asthma
  • Diabetes
  • Cancer
  • Pregnancy

#3: Refusal To Send Quotes

You are most likely being scammed if you’re being asked to give personal info to receive a quote. The same “agents” who are refusing quotes will be the first ones to send you their “license” information to try to legitimize their offers.
Be proactive and compare prices for health plans, check your eligibility, and begin enrollment through an official government site.

#4: Asked To Join an Association

If you’re being asked to join an association or union to start coverage, this is a sign that you are being scammed. Verify you are purchasing insurance from a reliable source. 

Special Enrollment Period Eligibility for Businesses and Individuals When You Experience a Qualifying Life Event

For a qualifying life event, there’s a timeframe for individuals by state – 60 days. For groups, the standard is 30-31 days to make changes and additions. 

Loss of Health Coverage

Loss of health coverage can include losing your existing individual, student, or job coverage. Once a person turns 26, they lose coverage through their parent’s plan.
A person who becomes ineligible for…

  • Medicare
  • Medicaid
  • CHIP

…can also lose their coverage.

Changes in Household

The following are considered changes in the household:

  • Getting married
  • Getting divorced
  • Having a baby
  • Adopting a baby
  • Death

Changes in Residence

When you move to a different country or ZIP code, you have a change in residence.
Additionally, the following situations are considered changes in residence:

  • A student leaving their school address
  • A seasonal worker moving to a new location
  • Going to or leaving a shelter or another transitional housing option

Other Qualifying Events

A change in your salary can affect the coverage available to you.
Other events that can affect your coverage include:

  • Becoming a US citizen
  • Working for AmeriCorps
  • Leaving jail
  • Becoming a member of a tribe that is recognized federally

Nevada Benefits: Helping Businesses and Individuals Get Access to Affordable Health Insurance

Insurance coverage can get tricky. Don’t make a mistake; get help from professionals.
Nevada Benefits is proud to offer options for small businesses, non-profits, individuals, and families. We are ready to share our experience concerning individual insurance, group insurance, and 401K and pensions.
Our team helps families and businesses thrive and grow while having peace of mind when dealing with insurance options. We want you to live a happier and healthier life while getting the most out of your health insurance coverage.

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